Ch5 - Creatine Monohydrate

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What is it?
Creatine is formed in the human body from the amino acids methionine,
glycine, and arginine. Creatine is stored in the human body as creatine
phosphate (CP) or phosphocreatine. The average persons body contains
approximately 120 grams of creatine stored as creatine and creatine phos-
phate.
Creatine can also be supplied by foods. Certain foods such as beef, her-
ring, and salmon, are fairly high in creatine, but a person would have to eat
pounds of these foods daily to equal what can be found in one teaspoon of
powdered creatine from a supplement.
What is it supposed to do?
During short maximal bouts of exercise such as weight training or sprint-
ing, stored adenosine triphosphate (ATP) is the dominant energy source.
However, stored ATP is depleted rapidly. To give energy, ATP loses a phos-
phate and becomes adenosine diphosphate (ADP). At this point, the ADP
must be converted back to ATP to derive energy from this energy produc-
ing system.
When ATP is depleted, it can be recharged by creatine, in the form of cre-
atine phosphate. That is, the CP donates a phosphate to the ADP making it
ATP again. An increased pool of CP means faster and greater recharging of
ATP and, therefore, more work can be performed for a short duration, such
as sprinting, weight lifting and other explosive anaerobic endeavors.
Other efects of creatine may be increases in protein synthesis and increased
cell hydration, though researchers are still elucidating the mechanisms.
What does the research say?
The above is, of course, an immensely oversimplifed review of an excep-
tionally complex system, but the basic explanation is correct. To date, re-
search has shown ingesting creatine can increase the total body pool of CP
which leads to greater generation of force with anaerobic forms of exercise,
Creatine Monohydrate
Chapter 5/ Creatine Monohydrate
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such as weight training, sprinting, etc.
Early research with creatine showed it can increase lean body mass and
improve performance in sports that require high intensity intermittent ex-
ercise such as sprinting, weight lifting, football, etc.
Creatine has had spotty results in research that examined its efects on en-
durance oriented sports such as swimming, rowing and long distance run-
ning, with some studies showing no positive efects on performance with
endurance athletes.
Whether or not the failure of creatine to improve performance with endur-
ance athletes was due to the nature of the sport or the design of the stud-
ies is still being debated. But one thing is for sure; the research is stronger
in high intensity sports of short duration.
Recent fndings with creatine monohydrate have confrmed previous re-
search showing its a safe and efective supplement. More recent research
has focused on exactly how it works, and has looked deeper into its poten-
tial medical uses.
Several studies have shown it can reduce cholesterol by up to 15%, and
may be useful for treating wasting syndromes such as HIV. Creatine is also
being looked at as a supplement that may help with diseases afecting the
neuromuscular system, such as muscular dystrophy (MS) and others.
A plethora of recent studies suggest creatine may have therapeutic ap-
plications in aging populations, muscle atrophy, fatigue, gyrate atrophy,
Parkinsons disease, Huntingtons disease, and other mitochondrial cytopa-
thies, neuropathic disorders, dystrophies, myopathies and brain patholo-
gies.
The importance of creatine is underscored by creatine defciency disorders:
inborn errors of metabolism that prevent creatine from being manufac-
tured. People born without the enzyme(s) responsible for making creatine
sufer from a variety of neurological and developmental symptoms which
are mitigated with creatine supplementation.
As for safety, some have suggested that creatine might increase the need
for extra fuid intake to avoid potential dehydration and muscle pulls. Still,
creatine has not been shown to increase either dehydration or muscle pulls
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in the research. In some people, creatine may increase a by-product of cre-
atine metabolism called creatinine, which is a crude indicator but not a
cause of kidney problems.
Some doctors have mistakenly thought that high creatinine levels (in
athletes using creatine) are a sign of kidney problems, but that is not the
case.
Creatinine is not toxic to the kidneys and most doctors are not aware that
creatine may raise creatinine levels with no toxicity to the kidneys. People
with pre-existing kidney problems might want to avoid creatine due to the
efects it can have on this test, though creatine supplementation has never
been shown to be toxic to the kidneys and the vast number, of studies to
date have found creatine to be exceedingly safe.
Its interesting to note that there has been a concerted efort by many
groups and ignorant medical professionals to portray creatine as being
somehow poorly researched (fatly untrue) and unsafe for long term use.
They systematically ignore the dozens of studies that exist showing its
both safe and efective. Even more bizarre, they ignore the recent studies
that are fnding creatine may help literally thousands of people with the
aforementioned diseases. This is unscientifc, unethical, and just plain im-
moral, in my view.
One question that often comes up regarding creatine is whether or not the
loading phase is required. Originally, the advice for getting optimal results
was to load up on creatine followed by a maintenance dose thereafter. This
advice was based on the fact that the human body already contains ap-
proximately 120 grams of creatine (as creatine and creatine phosphate)
stored in tissues and to increase total creatine stores, one had to load for
several days in order to increase those stores above those levels.
The idea also seemed to work well, in practice, with people noticing con-
siderable increases in strength and weight during the loading phase. All
was not perfect however as many people found the loading phase to be a
problem, with gastrointestinal upset, diarrhea and other problems. At the
very least, loading was inconvenient and potentially expensive.
The need for a loading phase was a long held belief, but is it really needed
to derive the benefts of creatine? The answer appears to be no, as both
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research and real world experience have found the loading phase may not
be needed after all. A 1996 study compared a loading phase vs. no loading
phase among 31 male subjects.
The subjects loaded for 6 days using 20 g/day and a maintenance dose 2
g/day for a further 30 days. As expected, tissue creatine levels went up ap-
proximately 20 percent and the participants got stronger and gained lean
mass. Nothing new there! And, not surprisingly, without a maintenance
dose creatine levels went back to normal after 30 days.
Then the group was given 3g of creatine without a loading dose. The study
found a similar - but more gradual - increase in muscle creatine concen-
trations over a period of 28 days. The researchers concluded:
...a rapid way to creatine load human skeletal muscle is to ingest 20 g of cre-
atine for 6 days. This elevated tissue concentration can then be maintained by
ingestion of 2 g/day thereafter. The ingestion of 3 g creatine/day is, in the long
term, likely to be as efective at raising tissue levels as this higher dose.
A more recent study done in 1999 found that 5 g of creatine per day with-
out a loading phase in 16 athletes signifcantly increased measures of
strength, power, and increased body mass without a change in body fat
levels (whereas the placebo group showed no signifcant changes).
The researcher of this 1999 study concluded:
...these data also indicate that lower doses of creatine monohydrate may be
ingested (5 g/d), without a short-term, large-dose loading phase (20 g/d), for
an extended period to achieve signifcant performance enhancement.
So, if you have sufered through the loading phase in the past thinking it
was the only way to maximize the efects of your creatine supplement, it
appears you can rest assured you dont have to go through all that hassle.
A 3 - 5 gram per day dose over an extended period of time will probably do
the same thing.
What does the real world have to say?
What can I say? Creatine monohydrate is one of the most widely used sup-
plements in bodybuilding, and I know of very few people who feel that
they havent gotten good results from using it.
. . . a rapi d way
to creati ne l oad
human skel et al
muscle is to ingest
20 g of creati ne
for 6 days. This
el ev at ed t i ssue
concentration can
then be maintained
by ingestion of 2
g/day thereafter.
The ingestion of 3
g creatine/day is,
i n the long term,
likely to be as ef-
fective at raising
tissue levels as this
higher dose.

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Recommendations:
Creatine can be found in the form of creatine monohydrate, creatine ci-
trate, creatine phosphate, tri- creatine malate, creatine-magnesium chelate
and even liquid creatine serum. The newest form being touted as the best
invention since the discovery of testosterone is creatine ethyl ester. How-
ever, the vast majority of research to date showing creatine efects on mus-
cle mass and performance used the monohydrate form and most creatine
found in supplements is in the monohydrate form.
There are many and surprisingly complicated problems with the above
forms, but I will do my best to cover the essential issues. For one thing,
these forms have little or no research supporting any of their claims, some
of which are either totally outlandish, or biologically impossible. Many
companies selling these products make claims, for example, that creatine
monohydrate is poorly absorbed and or poorly metabolized by the body.
This is simply untrue: research has found that creatine monohydrate is
highly absorbable. Some claim less bloating or other supposed efects of
monohydrate, but dont have a drop of data to support the claim, or even
a feasible theory as to why their form would not have the efect vs. the
monohydrate form.
They often claim dramatically improved absorption over monohydrate
(without data), fewer side efects (without data), the ability to reduce the
number of non-responders to creatine (without data), etc. Are you starting
to see a theme here?!
Now, its not impossible for example, that a creatine citrate or malate (both
of which are simply creatine bound to a TCA cycle intermediate) may work
for a higher percentage of people than the monohydrate form, thus reduc-
ing the number of non-responders, but it has yet to be proven.
It may be that the creatine-magnesium chelate form the most interest-
ing form of the group in my view may be superior to the monohydrate
form for adding LBM or strength, but there has yet to be a single head-to-
head study that compared one version to the other. That people are get-
ting some results from these new forms is all well and fne, but are those
results above and beyond that of monohydrate? If so, is it simply from the
malate, citrate, or magnesium? If a study was to fnd that an equal amount
of creatine-malate, citrate, etc. was 10 percent more efective than mono-
hydrate, but was 4 times as expensive, would you get the same results just
. . . t hese dat a
also indicate that
lower doses of cre-
atine monohydrate
may be i ngested
(5 g/d), without a
short-term, large-
dose loading phase
(20 g/d) for an
extended period to
achieve significant
performance en-
hancement.

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taking a little more monohydrate? The answer to all those questions, which
must be answered to recommend using any of these new forms, is (drum
roll) unknown.
So, here we have what may be the most well-researched supplement
known to mankind (the monohydrate form), that has been shown to be
cheap, safe, and efective, and people clamor for more expensive, poorly
researched forms (e.g., malate, citrate, etc.), because some supplement
companies tell them its superior to the monohydrate form! Now, if people
want to spend their money on other forms of creatine, there is nothing
wrong with that per se, but they should at no time be under the impression
(no matter how much the supplement company selling it claims) that what
they are buying has been proven to be superior to the monohydrate form.
For increases in strength, LBM, and performance, creatine monohydrate
gets an enthusiastic thumbs up.
To discuss Creatine Monohydrate further, you can post in the Members
Area.
References
Brewer GJ and Wallimann TW. Protective efect of the energy precursor
creatine against toxicity of glutamate and beta-amyloid in rat hippocam-
pal neurons. J Neurochem. 2000 May;74(5):1968-78.
Earnest CP, Almada AL, and Mitchell TL. High-performance capillary
electrophoresis-pure Creatine monohydrate reduces blood lipids in men
and women. Clin Sci (Lond). 1996 Jul;91(1):113-8.
Ferrante RJ, Andreassen OA, Jenkins BG, et al. Neuroprotective efects
of creatine in a transgenic mouse model of Huntingtons disease. J Neuro-
sci. 2000 Jun 15;20(12):4389-97.
Hultman E, Soderlund K, Timmons JA, et al. Muscle creatine loading in
men.J Appl Physiol. 1996 Jul;81(1):232-7.

Klivenyi P, Ferrante RJ, Matthews RT, et al. Neuroprotective efects of
creatine in a transgenic animal model of amyotrophic lateral sclerosis. Nat
Click Here
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Med. 1999 Mar;5(3):347-50.

Kreider RB, Ferreira M, Wilson M, et al. Efects of creatine supplementa-
tion on body composition, strength, and sprint performance. Med Sci Sports
Exerc. 1998 Jan;30(1):73-82.
Malcon C, Kaddurah-Daouk R, Beal MF. Neuroprotective efects of cre-
atine administration against NMDA and malonate toxicity. Brain Res. 2000
Mar 31;860(1-2):195-8.
Matthews RT, Yang L, Jenkins BG, et al. Neuroprotective efects of cre-
atine and cyclocreatine in animal models of Huntingtons disease. J Neuro-
sci. 1998 Jan 1;18(1):156-63.
Matthews RT, Ferrante RJ, Klivenyi P, et al. Creatine and cyclocreatine at-
tenuate MPTP neurotoxicity. Exp Neurol. 1999 May;157(1):142-9.
Odland LM, MacDougall JD, Tarnopolsky MA, et al. Efect of oral creatine
supplementation on muscle [PCr] and short-term maximum power output.
Med Sci Sports Exerc. 1997 Feb;29(2):216-9.
Pearson DR, Hamby DG, et al. Long-term efects of Creatine monohydrate
on strength and power. J Strength Cond Res. 1999 13(3):187-92.
Peeters BM, Lantz CD and Mayhew JL. Efect of oral creatine monohy-
drate and creatine phosphate supplementation on maximal strength in-
dices, body composition, and blood pressure. J Strength Cond Res. 1999
13(1):3-9
Poortmans JR, Auquier H, Renaut V, et al. Efect of short-term creatine
supplementation on renal responses in men. Eur J Appl Physiol Occup Physi-
ol. 1997;76(6):566-7.
Poortmans JR, Francaux M. Long-term oral creatine supplementation
does not impair renal function in healthy athletes. Med Sci Sports Exerc.
1999 Aug;31(8):1108-10.
Tarnopolsky M, Martin J. Creatine monohydrate increases strength in pa-
tients with neuromuscular disease. Neurology. 1999 Mar 10;52(4):854-7

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Volek JS, Duncan ND, Mazzetti SA, et al. No Efect of Heavy Resistance
Training and Creatine Supplementation on Blood Lipids. Int J Sport Nutr Ex-
erc Metab. 2000 Jun;10(2):144-56.
Walter MC, Lochmuller H, Reilich P, et al. Creatine monohydrate in mus-
cular dystrophies: A double-blind, placebo-controlled clinical study. Neu-
rology. 2000 May 9;54(9):1848-50.


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